The present invention is in the field of surgical apparatus and methods and is more specifically directed to apparatus and methods for effecting a radical prostatectomy which avoids the shortcomings of the prior known procedures for such operations. The invention is also intended for general use in tubular anastomosis.
Impotence frequently results from radical prostatectomy operations as a consequence of injury to the branches of the pelvic plexus that are necessary for the sexual function. Additionally, incontinence is also regrettably a frequent occurrence resulting from prior known radical prostatectomy procedures. The occurrence of most cases of impotence and incontinence arises as a consequence of three factors inherent in present procedures. The first factor is the presently employed surgical procedures involved in the anastomosis of the distal urethra and the bladder neck results in trauma and injury to the nerves adjacent the apex of the prostate and the urethra. The second factor is post-operative leakage resultant from the fact that the anastomosis is frequently not liquid-tight so that urine leaks outside the anastomosis, resulting in scarring and distortion of the bladder neck with possible encasement of the nerves. The third factor is obstructions from intra-lumenal bladder neck contracture.
The prior procedure for effecting anastomosis require the surgeon to suture the urethra in a "blind" area beneath the symphysis pubis in which it is not possible to see the area being sutured. Consequently, imperfect anastomosis and nerve damage frequently result. Moreover, the prior known surgical procedures employed in the anastomosis suffer from the further shortcoming of being extremely time consuming and tedious, factors which decrease the surgeon's skill and the patent's stamina.
While prior devices such as that shown in U.S. Pat. Nos. 4,304,236, 4,485,817 and 4,553,543 have been proposed for performing anastomosis of large body ducts or lumens such as the bowel, such devices are not usable for joining the smaller body tubes such as the urethra due, among other things, to their large size and the fact that they cannot be scaled down to a sufficiently small size as to be usable in the urethra.